Professor Valerio Nobili

Q. Professor Nobili, what was the scope of the Pediatric Hepatology School?

The hepatology landscape has changed dramatically in the past year. New regimens and ever-higher cure rates for hepatitis C (HCV), an even greater focus on fatty liver disease, and new organ allocation policies and procedures for liver transplantation are among the changes affecting clinical practice. In 2017, AISF launched the first Pediatric Hepatology School, which took place in Rome at the Bambino Gesu’ Children’s Hospital. The purpose of this school was to hear experts discuss the latest in both the management and treatment of HBV and HCV and the breadth of liver disease including: NAFLD, Primary Biliary Cholangitis, Disorders of Iron Metabolism in Patients with Liver Disease, Hepatic Encephalopathy, Complications of Cirrhosis, and Hepatocellular Carcinoma. Finally, experts and attendees focused on the debated topic of ‘transition programs’.

Q. What is a Transition Program?

Seven young researchers from Italian and French Tertiary Hepatogastroenterology Centers attended the school. It was fascinating that none of the participants were pediatricians, but all were very interested in knowing “the pediatric face” of adult hepatic disorders.

All clinics and surgical specialists generally involved in the diagnostic and therapeutic work-up of pediatric patients affected by chronic hepatopathies participated as speakers during the course, such as pathologists, hepatobiliary surgeon, pediatric hepatogastroenterologists, and radiologists.

The entire school was based on an intense interaction between “teachers” and “attendees” and reserved plenty of time for personal discussion and exchanges with distinguished faculty. There was a balanced blend of lectures addressing theoretical as well as practical issues and clinical case – based discussions.

Q. Which areas of hepatology were covered?

The participants attended the Hepatometabolic and Gastroenterology and Nutrition Department of Bambino Gesù Children’s Hospital, observing the clinical cases of patients hospitalized during the days of the school. The diagnostic and therapeutic pediatric approaches were therefore practically discussed in the ward by examining the inpatient cases. For example, cases of neonatal cholestasis, chronic hypertransmiasemia, short bowel syndrome, and children treated with liver transplantation or with end stage chronic liver diseases waiting for transplantation. Moreover, a discussion section was reserved for clinically intriguing cases, which were presented by attendants to experts of “Bambino Gesù” Children’s Hospital for a useful “face to face” debate.

Q. Did the School touch on research topics too?

Another stimulating part of the school program was the visit in small groups to the Liver Research Unit of ‘Bambino Gesù’ Children’s Hospital. During this visit, attendees received a rapid overview of basic research relevant to hepatology, with the goal to improve the knowledge of participants on more recent and useful molecular and cellular techniques in the study of liver diseases. This visit also offered the opportunity to stimulate new ideas and research projects and/or collaboration with young investigators who attended the school.

Q. Should pediatricians have a place in the multidisciplinary team treating liver disease of adults?

The actual topic of transition program was addressed with a round table that involved pediatric hepatologists and adult hepatologists. In this interesting debate, the importance of a shared multidisciplinary approach in the management of young adults with childhood liver disease was highlighted. The shared opinion was that a joint structure, including both pediatric and adult staff, would be the “ideal” introduction for young people to the adult medical world.

Q. What message stemmed from the Pediatric Hepatology School?

We have assembled experts in both adult and pediatric hepatology to digest and synthesize a wide range of extremely important approaches for clinicians to know about. Attendees were able to learn in a mere three days what would otherwise take days of going to talks and reading journal articles to figure out. Attendees could sit back and enjoy learning the newest, most exciting and most clinically relevant developments of the past year in pediatric hepatology. Moreover, they were also stimulated to present and propose new insights into the field of liver diseases.